1.3 Content Outline & Study Plan

How ARRT built this exam

ARRT does not harvest random facts from textbooks. Examination committees survey practicing cardiac interventional radiographers, then publish a task inventory — the job responsibilities an entry-level CI technologist actually performs. From that inventory they write Examination Content Specifications. The CI_CS_2023 document states the rule in one sentence: every content category can be linked to one or more tasks on the task inventory. If a topic is on the exam, someone in a cath lab does it. If a topic is popular on social media but absent from the task inventory, it is a poor use of the week before Pearson VUE.

That construction order should change how you study. You are not memorizing a secret question bank. You are learning the cognitive layer of work you already (or will) scrub, circulate, or monitor. When the outline lists flow reserve, it is because technologists set up and document fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting full-cycle ratio (RFR) cases. When it lists hazardous materials, it is because you handle sharps, blood, tissue samples, and occasionally radioactive or chemotherapeutic material in the suite.

Download four ARRT PDFs and keep them next to this guide: the task inventory, content specifications, structured education outline, and clinical experience requirements. The last two also reprint the content outline, so your CE hours, clinical log, and exam topics should line up. A CE course that never mentions sterile technique will not cover Patient Care for structured education, and a study plan that never mentions closure devices will miss a Focus-of-Questions target that can appear on any Procedures item.

The three scored domains — and the Procedures overlay

Patient Care (40 scored items) is one subcategory: Patient Interactions and Management. It is not "soft skills." It includes pre-, intra-, and postprocedure communication and time-out; history, allergies, and medications; NPO and consent; positioning; Allen and Barbeau access assessment; chemistry, hematology, coagulation, and arterial blood gas values; physiologic monitoring; contrast types; anticoagulants, antiplatelets, thrombolytics, vasoactives, sedation, and emergency drugs; asepsis; and a long emergency list from contrast reactions and contrast-induced nephropathy through tamponade, dissection, hematoma, and flash pulmonary edema.

Image Production (20 scored items) is Image Acquisition and Equipment: fluoroscopy dose and pulse modes, digital acquisition and frame rate, roadmapping and digital subtraction, field of view, filters, 3D, projections, post-processing and PACS, automatic pressure injectors, and basic operation of ultrasound, IVUS, OCT, and ICE. Radiation protection — collimation, magnification, geometry, last-image hold, personnel ALARA (as low as reasonably achievable), monitoring, and apron QC — lives here, not only in a generic radiography memory from your R.T.(R) exam.

Procedures (85 scored items) splits into Diagnostic and Electrophysiology (35) and Interventional (50). Diagnostic/EP covers right and left heart hemodynamics; coronary, graft, pulmonary, aortic, and ventricular angiography; ICE; flow reserve; intravascular imaging; biopsy; peripheral and access-site angiography; and the calculation set: stroke volume, Gorlin and Hakki valve area, shunts, and cardiac output by Fick, thermodilution, and angiographic methods, plus EP detection, ablation, cardioversion, pacemakers, ICD, and lead extraction. Interventional covers angioplasty, atherectomy, stents, thrombectomy, IVC filters, pericardiocentesis, IABP, foreign-body retrieval, catheter-based VAD, IVL, ECMO, distal protection, and structural work (PFO/ASD, VSD, TAVI/TAVR, valvuloplasty, TMVR, LAA closure).

Focus of questions — the extra layer on every Procedures item

ARRT prints a Focus of Questions box on every Procedures page of the outline. A Procedures item may also test:

1. Anatomy and pathophysiology
2. Indications for the procedure
3. Contraindications
4. Image analysis and utilization
5. Access methods
6. Ultrasound guidance
7. Equipment and devices — types, indications, and setup of sheaths, catheters, guidewires, needles, and manifold/pressure transducers
8. Complications — recognition and treatment
9. Closure devices, puncture-site pressure, and dressings (manual, external, permanent, nonpermanent, surgical glue)
10. Interventional suite and hybrid operating room (OR)

Exam trap: a TAVR question is not only "what is TAVI." It may be femoral versus alternative access, ultrasound-guided puncture, which sheath the valve needs, how the aortogram should look, what tamponade looks like after wire perforation, and how you close a large-bore site. Study devices and complications beside the procedure name.

Weight-matched study sequence

Match hours to scored items, not to whatever chapter feels comfortable.

Start with Interventional (50 items). If you can explain angioplasty, stent platforms, atherectomy modes, thrombectomy choices, mechanical support, and the structural list — including complications and closure — you have covered more than one-third of the scored exam. Then Diagnostic and EP (35): coronary projections and dominance, graft shots, ventriculography, RHC waveforms, and EP implants. Fold high-yield calculations into this block every week: cardiac output (Fick, thermodilution, angiographic), Gorlin and Hakki valve area, shunt detection, and FFR/iFR/RFR interpretation. Those items are slow on test day if you have never worked a problem with the on-screen calculator.

Next Patient Care (40). Use real cases: the radial STEMI with a borderline creatinine, the patient on a direct oral anticoagulant, the time-out that catches a laterality error, the hematoma forming after a failed closure device. Last Image Production (20). Twenty items can still fail a candidate who ignores pulse rate, injector safety, or occupational dose reports, but those 20 should not crowd out 50 interventional items.

A planning calendar for working technologists

ARRT does not publish a required study-hour figure. For a full-time cath-lab tech who already sees LHC and PCI, a realistic planning estimate is 140–200 hours over 8–14 weeks. That is an OpenExamPrep planning range, not an ARRT rule. A tech who only recently moved from diagnostic radiography into the lab should bias toward the high end and toward more calculation and EP hours. A tech who already scrubs complex PCI and structural cases can compress the calendar but should still drill the Focus-of-Questions layer and Patient Care labs/drugs rather than assuming muscle memory equals exam language.

A simple 12-week sketch:

• Weeks 1–5: Interventional procedures + device/complication/closure overlay (about 8–12 hours/week).
• Weeks 4–8: Diagnostic angiography, hemodynamics, and calculation problem sets (overlap one week with PCI so formulas sit next to waveforms).
• Weeks 7–10: EP implants and ablation workflow; Patient Care labs, contrast, meds, and emergencies.
• Weeks 10–12: Image Production, radiation protection, mixed timed practice, and weak-topic repair.

Use free practice questions at /practice/arrt-cardiac-interventional to find holes, then return to this guide's later chapters. Practice items are a study aid, not ARRT's exam. When an item bank feels easier than your last STEMI night, remember the real test will mix a Hakki calculation, a hybrid-OR traffic pattern, and a sterile-field break in random order.

Cath-lab scenario. You circulate a TAVR. The outline will not ask only for the valve brand. It can ask why ultrasound guidance was used for femoral access, which manifold transducer zero point is correct, how an aortogram confirms implant height, what hypotension after the post-dilatation balloon suggests (for example tamponade versus vascular rupture), and whether a large-bore closure device or surgical cut-down is in play. That single case touches Procedures, Patient Care monitoring, and Image Production cine/fluoro choices. Study cases the way the task inventory built the exam: as whole jobs, not isolated buzzwords.

Keep the official 40/20/85 table on the first page of your notes. If your highlighter time does not roughly match 58.6% Procedures, 27.6% Patient Care, and 13.8% Image Production, adjust before you spend another weekend on a low-yield rabbit hole.